Net Vision Internet Services Domain Name Registration Form

	*Fast and Reliable Web Site Hosting* Domain Name Registration Form If any of the details are not applicable, please leave blank. If you are unsure of any of the details, which may relate to you, please make a note of them in the "Comments" field at the end of this form and we will endeavour to find them out for you. Please note that unless a domain name is being applied for by a private individual, the registration application must be placed in the name of the business or company that is making the application. Registrations by companies, partnerships, sole traders, or registered associations must be accompanied by an ACN or registered business number. If you do not know what yours is, a search facility is available on the Australian Security And Investment Commission web site. The registration of .com.au domain name has quite specific rules of eleigibility. Please refer to the AUNIC Domain Name Allocation Policy for more information. IMPORTANT: If the domain name that you require relates to your trading name rather than your company name, business name registration details must also be provided to support your application.
	Domain Name Required:

	Who Is Building Your Site:
	Their Phone Number:
	Their E-Mail Address:

	Your Company Name:	If Applicable
	ACN / ABN:	If Applicable
	Registered Business Name:	Required
	Registered Business Number:	Required
	State Of Registration:	Required

	NIC Handle:	If you don't know what a NIC Handle is, then you won't need to fill this in.

	Postal Address:	Required
	City, State, Postcode:	Required
	Telephone:	Required
	Facsimile:
	E-Mail:


	Contact Name:	Required
	Position:
	E-Mail:	Required

	Purchase Order Number:	If Applicable

	Requirements:	Budget - AU$16.50/Month (5M/B + 1 E-Mail Address) Standard - AU$27.50/Month (10M/B + 5 E-Mail Addresses) Premium - AU$38.50/Month (20M/B + 10 E-Mail Addresses) All prices above include GST.

	Extras (AU$2.20 per Unit/Mth):	Additional E-Mail Addresses Additional M/Bytes of Web Space Other If other, please specify:

	E-Mail Configuration:	A default primary E-Mail address needs to be set up. It is usually something like info@ or sales@yourdomian.com.au. What would you like yours to be? @yourdomain.com.au Have E-Mail held at this address for collection. Have all E-Mail received at this address redirected to my current E-Mail address of:

	Comments: